Serological Response to Third Dose of Sars-Cov-2 Mrna Vaccine in Patients Affected by Thymic Epithelial Tumors Who Did Not Achieve Seroconversion after the Second Dose

Background: Thymic epithelial tumors (TETs) are rare malignancies associated with dysregulation of the immune system with humoral and cell mediated immunity abnormalities. Anti-syndrome coronavirus type 2 (SARSCoV- 2) vaccine is effective at preventing COVID-19 morbidity and mortality. No published data are available regarding the post-vaccine immunization in TET patients (pts). The aim of our study was to evaluate the immunization in TET pts, who received the third mRNA vaccine dose and who did not achieve seroconversion after the previous two doses. Method(s): Starting from November 2021 to March 2022, 23 consecutive TET patients (pts) found to be serologically negative after two doses of SARS-Cov-2 mRNA vaccine (BNT162b2 by Pfizer-BioNTech) were enrolled at the Rare Tumors Coordinating Center of Campania Region (CRCTR-Naples, Italy). SARS-CoV-2 spike-binding IgG antibody serological levels were centrally analyzed by chemiluminescent immunoassay (CLIA) at two different time-points: T0 (before the third dose) and T1 (one month after the third dose). Cut-off for Ab titers positivity was >25 AU/mL. Result(s): Among the 23 enrolled pts, 10 (43,5%) were female and 13 (56,5%) males;17 pts had thymoma and 6 thymic carcinoma. Autoimmune disorders were detected in 20 TET pts (87%), of whom 3 (15%) suffered from Myasthenia Gravis, 8 (40%) from Good's Syndrome, 7 (35%) from both diseases, and 2 (10%) from other autoimmune disorders. By the time of third vaccine dose 2 pts had died, 2 pts were lost to follow up, 5 pts had suffered from SARS-CoV-2 infection. Of the remaining 14 pts, 7 achieved seroconversion whereas 7 maintained negative serological antibody titers. Two of these 7 pts had SARSCoV- 2 infection after the third dose. Interestingly, among these 7 pts who did not develop positive antibody titers, 6 had active cancer disease and only one was diseasefree. Moreover, 6 out of these 7 pts suffered from Good's Syndrome. On the other hand, among the 7 pts who developed positive antibody titers, only 3 had active disease. Conclusion(s): Our preliminary results showed that TET pts who did not achieve seroconversion even after the third SARS-Cov-2 vaccine dose in most cases had active cancer disease. If confirmed on larger cohorts of patients, these data may have important clinical implications and may help to better identify fragile pts who could benefit the most from prophylactic therapy with monoclonal antibodies.

Integrated screening and testing for TB and COVID-19 in Peru

We describe the experience of integrating COVID-19 screening and testing into a mobile TB screening unit in Lima, Peru. All attendees received chest radiographs, which were analysed using CAD4TB and CAD4COVID;Xpert MTB/RIF Ultra was used to test for TB, and antibody and polymerase chain reaction (PCR) for SARS-CoV-2. One Xpert-positive TB case was diagnosed per 168 people screened, one person with SARS-CoV-2 antibodies per 3 people screened, and one PCR-confirmed SARS-CoV-2 infection per 8 people screened. Integrated screening can help to avoid delays in the diagnosis of both TB and COVID-19.

DESIGN INNOVATION of BICYCLE FRAMES EXPLOITING TOPOLOGY OPTIMIZATION

In recent years, the use and demand of bicycles have increased thanks to the growing attention to the environment and due to the COVID-19 pandemic situation. At the same time, the design of the bicycles has remained substantially unchanged, improving in materials and components technology. In the off-road sector, two diametrically opposed categories have emerged in terms of comfort and pedalling efficiency. The goal of this research is to introduce a first methodological approach for the optimization of a mountain bike frame. The behaviour of the developed frame aims to combine the pedalling benefits now available only in different and non-comparable bicycle configurations. The first step concerns the modelling of a generic off-road bicycle frame, then its behaviour has been simulated for specific load cases. Subsequently, the part of the bicycle that best performed the double function of compliance and rigidity has been sought through an analysis of the strain energy using FE simulations. Hence, the reference region has been topologically optimized to provide adequate chassis travel performance. The analysis scheme has been iteratively repeated also on other parts of the frame until an acceptable solution is obtained for the utilize presented. The final configuration permits a rear tube and bottom bracket displacement of 10.4 mm and 2.4 mm compared to the 0.5 mm and 0.4 mm of the original frame respectively. The approach described can be proposed as a support for the search for an innovative design for products with unchanged geometries due to the inertia of the designers. At the same time, this methodology aims to expand the possible use of topological optimization, moving away from the classic constraint schemes present in various software. © 2021 American Society of Mechanical Engineers (ASME). All rights reserved.

Moving forward to create a more sustainable and efficient obstetrics and gynecology emergency services requires a change of stance: What to learn from COVID-19 pandemic

INTRODUCTION In Italy, emergency services are free of charge and to public perception they have the utopian power to offer an immediate response to health problems.This causes inadequate emergency visits that are not cost-effective and could be harmful for the patients themselves. Since Gynecologists and Obstetrics working in emergency department have the impression that the number of pregnant and gynecological women who present themselves without any urgent reasons is increasing, the purpose of this study was to assess the impact of the COVID-19 pandemic on emergency department consults across obstetrics-gynecology services at AOU Policlinico G.Martino in Messina. Design: Retrospective cohort study. METHODS This is the first and only study to determine the volume of patients presenting to OB-GYN Emergency Department (our centre is a tertiary center with a catchment area of 60,000 women and 1500 deliveries each year) from March to October 2020 (across all the different 'legislative' stages of the COVID-19 pandemic) and compared them with the same months in 2019 as a control period. The primary outcome was the number of access to Ob-Gyn ED in the two study periods. The co-primary endpoint was the overload daily rate in the two study periods. Patients were divided into two groups: gynecologic and pregnant. Secondary outcomes were the admission rate, the discharge rate, the abandonment rate, the reasons for and the number of access for each category in the two period and related to the restrictions. We conducted a population-based analysis using anonymized data. The only exclusion criteria was COVID-19 positive patients, as they could not gain access because of regional health services reorganization. Comparisons were analyzed with chi-square. RESULTS A total of 6033 women self-referred to our OB-GYN ED were enrolled. During COVID-19 period the total number of OB-GYN self-referrals was 2617 compared to 3416 accesses occur during 2019 (considering our catchment area, the difference was 1.49 % p < .0001) and the daily overload rate was 33.5% (COVID-19 pandemic ) vs 43.75 % (2019), with a difference all over the period of 10.2% (p < .0001). These differences were stronger during the 'lock down' periods of March, April and October 2020 (differences of daily overload rates respectively: 15.9 %;19.9%;9%, p < .0001). The hospitalization rate was significantly higher both for gynecologic and pregnant patients during the COVID-19 pandemic suggesting that women were going to hospital for more serious problems. CONCLUSIONS There was a significant reduction in OB-GYN ED accesses and the hospitalization rate was higher during the 'lock down period' only, while there were not any differences during the 'light lock down months' compared to the same time in 2019. It may be indirect proof of the probably inappropriate use of the OB-GYN ED. COVID Pandemic has been a stress test for our health care system highlighting our critical points. This underlines the urgent need to identify new healthcare algorithms to reduce the workload of the Emergency Departments and at the same time to create more efficient diagnostic and treatment paths in order to generate a more efficient, sustainable welfare system and get ready for a new crisis.

Health surveillance during the COVID pandemic

Introduction: The health surveillance constitutes a fundamental measure of prevention for the workers who are exposed to risks for the health and, in extreme synthesis, it evaluates the effects on the health of such exposure, with the objective to adapt the measures of prevention to the peculiarities of the single worker and to verify the effectiveness of the adopted measures .The competent doctor organizes his own plan of activity and plans the health surveillance. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its associated disease (COVID- 19) have caused a worldwide health emergency that requires an integrated and multidisciplinary intervention by the international medical-scientific communities. Objective: Analyze and interpret the data inherent to the health surveillance of the Fondazione Toscana Gabriele Monasterio (FTGM), in the Healthcare plants of Massa and Pisa to counteract and limit the spread of SARS- CoV-2 and to maintain the status of Covid Free hospital. Materials and MethodS: The population sample examined consisted of all the staff working at FTGM's two facilities in Massa and Pisa. FTGM implemented the prevention systems in reference to the regulations of the Tuscany Region: monitoring and infection control through serological screening tests (initially only healthcare professionals and later on the all staff), single molecular swab (according to Tuscany regional regulations), then with pooling system. Results: From 18/03/20 to 31/12/20, 5228 swabs were performed (3748 people tested);261 people tested with pooling system (55 tests) in December;Covid-19 positive: n061 of which 32 were FTGM employees. Conclusions: As part of health surveillance, we believe that all healthcare workers should be tested for early detection of SARS-CoV-2 as happened at FTGM. The low percentage of positive swabs at our institution, allowed for the safeguarding of our fragile users in view of the fact that only one of our patients became positive during hospitalization.

Vaccination campaign at ftgm

Introduction: Influenza vaccination is the most effective way to prevent its seasonal periodicity which is a serious public health problem and a source of direct and indirect costs for measures control, cases management and emerging complications. Healthcare workers are, among the categories at most risk of contagion, those who tend to come into contact with influenza viruses, above average earlier than the rest of the population. Just this year, influenza vaccination has been recommended more strongly than in previous years for obvious reasons related to the current COVID-19 Pandemia. Influenza vaccination, in fact, allows to simplify the diagnosis and management of suspected cases, given the similar symptoms between COVID-19 and influenza, in order to limit complications from influenza in individuals at risk and, therefore, reduce access to emergency rooms. Objective: Fulfillment of the Company Vaccination Plan 2020/21 in such a way as to increase the real perception of the disease by the staff FTGM, evaluate the response to vaccine prophylaxis and document its effectiveness, especially in the interest of Public Health and patient safety. Materials and Methods: Meetings between the various company representatives will be held to implement the indications provided by the Ministry of Health for the correct planning of the vaccination campaign. Presentation of the Vaccination Plan on the FTGM corporate website. Personalized email addressed to all the staff with invitation to provide vaccination and the possibility of reserving the vaccine and signed consent forms through an apposite link. Realization of a promotional video with double interview system of the Competent Doctors. Availability of vaccine execution directly in the hospital unit and personalized sessions for other type of employees. Weekly availability in the presence and daily by the web-site of the Medical Competents for vaccination consent. Results: The 2020/21 vaccination campaign resulted in 518 actual vaccinations (74% of FTGM staff). In the previous years: campaign 2019/20 160 (22.8%);campaign 2018/19 120 (17.4%). In previous years the percentage recorded never exceeded 6%. Conclusions: An effective targeted Corporate Vaccine Plan, implemented in a multidisciplinary manner, supported by new and appropriate ideas and tools, combined with the ever-present willingness and dedication of the staff involved, has achieved excellent results with increased vaccination awareness in FTGM staff.

Riemergere: Le voci dei bambini/e, dei ragazzi/e e dei genitori durante l’emergenza COVID-19 in provincia di trento

Objectives: The survey was conducted in the province of Trento to collect and bring to the attention of the community the experiences, expectations and thoughts of children, teenagers and parents during the Covid-19 emergency, between the end of lockdown and the start of phase 2. Methods: Three different questionnaires were published online for children (5-8 years), teens (9-19) and adults with closed questions on different areas of daily life as well as with open questions about the future. Results: More than 21,000 people residents in Trentino participated in the survey, nearly 11,000 were minors. A varied picture emerges where isolation, changes in habits, distance learning and a lack of outdoor life are common factors, with significant differences expressed in the answers to the open questions. At the same time, the creative drive of the youngest emerges, their ability to broaden their gaze to the community and for the well being of all. Conclusions: The survey found considerable interest among children and young people in Trentino, giving them the opportunity to express themselves freely and for the community to collect valuable contributions for the “re-emerge” from the crisis. © 2020, Associazione Culturale Pediatri. All rights reserved.